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Int. braz. j. urol ; 48(2): 284-293, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364965


ABSTRACT A major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN. Materials and Methods: Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3). Results: Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography. Conclusions: We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

Humans , Child , Tissue Inhibitor of Metalloproteinase-2/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Biomarkers/urine , Insulin-Like Growth Factor Binding Proteins/urine , Tissue Inhibitor of Metalloproteinase-2/urine , Matrix Metalloproteinase 2 , Kidney/physiology
Article in English | WPRIM | ID: wpr-922356


PURPOSE@#To investigate the clinical value of urine interleukin-18 (IL-8), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for the early diagnosis of acute kidney injury (AKI) in patients with ureteroscopic lithotripsy (URL) related urosepsis.@*METHODS@#A retrospective study was carried out in 157 patients with urosepsis after URL. The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8, NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0, 4, 12, 24 and 48 h after the surgery. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.@*RESULTS@#The level of urine IL-8, NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4, 12, 24 and 48 h (p < 0.01). The ROC analysis showed the combined detection of urine IL-8, NGAL and KIM-1 at 12 h had a larger area under curve (AUC) than a single marker (0.997, 95% CI: 0.991-0.998), and the sensitivity and specificity were 98.2% and 96.7%, respectively. Pearson correlation analysis showed that the levels of urine NGAL at 4, 12, 24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18 (p < 0.01).@*CONCLUSION@#AKI could be quickly recognized by the elevated level of urine IL-8, NGAL and KIM-1 in patients with URL-related urosepsis. Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance, which may be an important reference for the early diagnosis of AKI.

Acute Kidney Injury/etiology , Biomarkers , Early Diagnosis , Hepatitis A Virus Cellular Receptor 1 , Humans , Interleukin-18 , Interleukin-8 , Lipocalin-2 , Lithotripsy , Retrospective Studies , Ureteroscopy
Arq. bras. cardiol ; 117(2): 385-391, ago. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1339147


Resumo Fundamento: A síndrome cardiorrenal tipo 1 associa-se a maior mortalidade em pacientes com insuficiência cardíaca (IC). No entanto, há escassez de publicações comparando critérios diagnósticos de lesão renal aguda (LRA). Objetivos: Analisar o perfil clinicofuncional de pacientes com IC e fatores associados a ocorrência de lesão renal aguda (LRA). Métodos: Estudo de coorte retrospectivo, em hospital terciário de região com baixo desenvolvimento econômico que incluiu pacientes com IC descompensada ou infarto agudo do miocárdio (IAM) recente, sendo avaliadas características clínicas, laboratoriais e ecocardiográficas comparativamente em pacientes com e sem LRA classificada pelos critérios Acute Kidney Network (AKIN) e Kidney Disease: Improving Global Outcomes (KDIGO). Nível de significância estatística com valor de p < 0,05. Resultados: Entre 81 pacientes, 61,73% evoluíram com LRA. A média de creatinina foi 1,79±1,0 mg/dL e de ureia 81,5±46,0 mg/dL, sendo maior no grupo com LRA (p < 0,05). Não foi evidenciada relação entre alterações cardíacas e redução da função renal. A doença renal crônica se associou a maior ocorrência de LRA (38% x 3,23% sem LRA, p = 0,001). Não houve diferença do KDIGO com relação ao critério AKIN. Os pacientes que desenvolveram LRA apresentaram maior mortalidade (32% x 9,8% no grupo sem LRA, p = 0,04, com odds ratio (OR) de 8,187 e intervalo de confiança 1,402-17,190, p = 0,020). Conclusão: Nessa casuística de pacientes com IC, a ocorrência de LRA foi elevada e foi fator de risco independente de mortalidade. As alterações cardíacas não se associaram à ocorrência de LRA, e os critérios diagnósticos KDIGO e AKIN apresentaram performance similar.

Abstract Background: Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. Objective: To assess clinical and functional features and factors associated AKI in patients with heart failure. Method: Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. Results: Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). Conclusion: In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.

Humans , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardio-Renal Syndrome/epidemiology , Brazil/epidemiology , Incidence , Retrospective Studies , Risk Factors , Cohort Studies , Renal Dialysis , Hospital Mortality , Kidney/physiology
Rev. bras. cir. cardiovasc ; 36(4): 484-491, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1347149


Abstract Introduction: High leuko-glycaemic index (LGI) (> 2000) has been associated with poor prognosis in many critical care settings. However, there is no evidence of LGI's prognostic value in the postoperative period of coronary artery bypass grafting (CABG). This study aims to analyze the prognostic value of LGI in the postoperative period of CABG. Methods: Single-center retrospective analysis of prospectively collected data was performed. Consecutive adult patients undergoing CABG between 2007 and 2019 were included. Blood glucose levels and white blood cells count were evaluated in the immediate postoperative period. LGI was calculated by multiplying both values and dividing them by 1,000 and analyzed in quartiles. Receiver operating characteristic curve was used to determine the best cutoff value. The primary combined endpoint was in-hospital mortality, low cardiac output (LCO), or acute kidney injury (AKI). Secondary endpoints included in-hospital death, AKI, atrial fibrillation, and LCO. Results: The study evaluated 3,813 patients undergoing CABG (88.5% male, 89.8% off-pump surgery, aged 64.6 years [standard deviation 9.6]). The median of LGI was 2,035. Presence of primary endpoint significantly increased per LGI quartile (9.2%, 9.7%, 11.8%, and 15%; P<0.001). High LGI was associated with increased occurrence of in-hospital mortality, LCO, AKI, and atrial fibrillation. The best prognostic cutoff value for primary endpoint was 2,000. In a multivariate logistic regression model, high LGI was independently associated with in-hospital death, LCO, or AKI. Conclusion: High LGI was an independent predictor of in-hospital mortality, LCO, or AKI in postoperative period of CABG. It was also associated with higher in-hospital death.

Humans , Male , Female , Glycemic Index , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Postoperative Complications , Postoperative Period , Prognosis , Coronary Artery Bypass , Retrospective Studies , Risk Factors , Hospital Mortality
Rev. Assoc. Med. Bras. (1992) ; 67(8): 1124-1129, Aug. 2021. tab
Article in English | LILACS | ID: biblio-1346965


SUMMARY OBJECTIVE Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI. METHODS This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm3). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (−). RESULTS CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p<0.001, respectively). Multivariate logistic regression analysis showed that PNI [odds ratio, OR: 1.631, 95% confidence interval (CI): 1.168-2.308, p=0.02] and estimated glomerular filtration rate (OR: 3.26, 95%CI 1.733-6.143, p<0.001) were independent risk factors for CI-AKI. CONCLUSIONS PNI is an independent risk factor for CI-AKI. The development of CI-AKI may be the mechanism responsible for the relationship between poor nutritional status and adverse cardiac events.

Humans , Acute Coronary Syndrome/complications , Acute Kidney Injury/etiology , Percutaneous Coronary Intervention/adverse effects , Prognosis , Nutrition Assessment , Risk Factors , Contrast Media , Creatinine
J. pediatr. (Rio J.) ; 97(4): 426-432, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287051


Abstract Objective To assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria - pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes -, and determining factors associated with acute kidney injury as well as its outcome. Methodology This was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted. Results The study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005-1.009), sepsis (PR 1.641, 95% CI: 1.128-2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095-2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681-3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%. Conclusion Older children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Severity of Illness Index , Intensive Care Units, Pediatric , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Intensive Care Units
Rev. bras. cir. cardiovasc ; 36(3): 354-364, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288230


Abstract Introduction: This study investigated the role of the neutrophil-lymphocyte ratio (NLR), the perioperative changes in NLR (delta-NLR), the platelet-lymphocyte ratio (PLR), and the platelet count in predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. Methods: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, in-hospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (non-AKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A "subsequent AKI group" was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. Results: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). Conclusion: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.

Humans , Coronary Artery Bypass/adverse effects , Acute Kidney Injury/etiology , Retrospective Studies , Risk Factors , Inflammation/etiology
J. bras. nefrol ; 43(1): 132-134, Jan.-Mar. 2021. graf
Article in English | LILACS | ID: biblio-1154669


Abstract This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.

Resumo O paciente era um homem de 73 anos de idade que inicialmente veio ao nosso serviço com insuficiência respiratória aguda secundária à COVID-19. Logo após a internação, ele foi submetido à intubação orotraqueal e pronado para melhorar a hipóxia devido à síndrome respiratória aguda grave (SARS - do inglês "severe acute respiratory syndrome"). No terceiro dia de internação, o mesmo desenvolveu lesão renal aguda oligúrica e sobrecarga de volume. O serviço de nefrologia foi acionado para realizar acesso venoso profundo para terapia renal substitutiva (TRS). O paciente não pôde ser colocado na posição de decúbito dorsal devido a uma hipoxemia significativa. Um Permcath de 50 cm (MAHURKARTM, Covidien, Massachusetts, EUA) foi inserido através da veia poplítea esquerda. Este relato de caso descreve um possível cenário desafiador com o qual o nefrologista intervencionista pode se deparar ao lidar com pacientes com COVID-19 com problemas respiratórios e colocados em pronação.

Humans , Male , Aged , Popliteal Vein , Critical Care/methods , Patient Positioning , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , COVID-19/complications , Respiratory Insufficiency/complications , Respiratory Insufficiency/therapy , Prone Position , Renal Replacement Therapy/methods , Fatal Outcome , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/therapy , SARS-CoV-2 , COVID-19/therapy , COVID-19/virology , Hospitalization , Intubation, Intratracheal/methods
J. bras. nefrol ; 43(1): 9-19, Jan.-Mar. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1154665


Abstract Background: Acute kidney injury (AKI) is a common complication in patients undergoing major abdominal surgery and is associated with considerable morbidity and mortality. Several studies investigating the association between intraoperative urine output and postoperative AKI have shown conflicting results. Here, we investigated the association of intraoperative oliguria with postoperative AKI in a cohort of patients submitted to elective major abdominal surgery. Methods: This was a single-center retrospective analysis of adult patients who underwent elective major abdominal surgery from January 2016 to December 2018. AKI was defined according to the serum creatinine criteria of the KDIGO classification. Intraoperative oliguria was defined as urine output of less than 0.5 mL/kg/h. Risk factors were evaluated using multivariate logistic regression analysis. Results: A total of 165 patients were analyzed. In the first 48 h after surgery the incidence of AKI was 19.4%. Postoperative AKI was associated with hospital mortality (p=0.011). Twenty percent of patients developed intraoperative oliguria. There was no association between preexisting comorbidities and development of intraoperative oliguria. There was no correlation between the type of anesthesia used and occurrence of intraoperative oliguria, but longer anesthesia time was associated with intraoperative oliguria (p=0.007). Higher baseline SCr (p=0.001), need of vasoactive drugs (p=0.007), and NSAIDs use (p=0.022) were associated with development of intraoperative oliguria. Intraoperative oliguria was not associated with development of postoperative AKI (p=0.772), prolonged hospital stays (p=0.176) or in-hospital mortality (p=0.820). Conclusion: In this cohort of patients we demonstrated that intraoperative oliguria does not predict postoperative AKI in major abdominal surgery.

Resumo Introdução: Lesão renal aguda (LRA) é uma complicação comum em pacientes submetidos a grandes cirurgias abdominais, e está associada a considerável morbimortalidade. Vários estudos investigando a associação entre débito urinário intraoperatório e LRA pós-operatória mostraram resultados conflitantes. Neste trabalho investigamos a associação de oligúria intraoperatória com LRA pós-operatória em uma coorte de pacientes submetidos à grandes cirurgias abdominais. Métodos: Análise retrospectiva de centro único envolvendo pacientes adultos submetidos à grandes cirurgias abdominais, de janeiro de 2016 a dezembro de 2018. A LRA foi definida segundo critérios de creatinina da KDIGO. Definimos oligúria intraoperatória como débito urinário inferior a 0,5 mL/kg/h. Fatores de risco foram avaliados por análise de regressão logística multivariada. Resultados: Analisamos 165 pacientes. Nas primeiras 48 horas após a cirurgia, a incidência de LRA foi de 19,4%. LRA pós-operatória foi associada à mortalidade hospitalar (p = 0,011). 20% dos pacientes desenvolveram oligúria intraoperatória, sem associação com comorbidades preexistentes. Não houve correlação entre o tipo de anestesia e oligúria intraoperatória; entretanto, maior tempo de anestesia esteve associado à oligúria intraoperatória (p = 0,007). Maior creatinina sérica (Cr) inicial (p = 0,001), necessidade de drogas vasoativas (p = 0,007) e uso de AINEs (p = 0,022) foram associados à oligúria intraoperatória. Oligúria intraoperatória não foi associada ao desenvolvimento de LRA no pós-operatório (p = 0,772), à permanência hospitalar prolongada (p = 0,176) ou à mortalidade intra-hospitalar (p = 0,820). Conclusão: Demonstramos que a oligúria intraoperatória não prediz LRA pós-operatória em cirurgias abdominais de grande porte.

Humans , Adult , Oliguria/etiology , Oliguria/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Cohort Studies
J. bras. nefrol ; 43(1): 20-27, Jan.-Mar. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1154663


ABSTRACT Introduction: Emergence of acute kidney injury (AKI) in patients with nephrotic syndrome (NS) requires prompt diagnosis and differentiation between acute tubular necrosis (ATN) and proliferative glomerulonephritis. We studied the potential use of commercial urinary biomarkers' tests in the diagnosis of AKI in patients with NS. Methods: A cross sectional estimate of urinary concentrations of KIM-1 and NGAL was performed in 40 patients with NS: 9 with proliferative glomerulopathy, being 4 with AKI and 31 without proliferative glomerulopathy, being 15 with AKI. AKI was defined using the KDIGO criteria. Results: The mean age was 35 ± 16 years. The main diagnoses were focal and segmental glomerulosclerosis (10, 25%), membranous glomerulopathy (10, 25%), minimal change disease (7, 18%), lupus nephritis (6, 15%), and proliferative glomerulonephritis (3, 8%). Patients with ATN had higher levels of urinary KIM-1 (P = 0.0157) and NGAL (P = 0.023) than patients without ATN. The urinary concentrations of KIM-1 (P= 0.009) and NGAL (P= 0.002) were higher in patients with AKI than in patients without AKI. Urinary NGAL and KIM-1 levels were significantly higher in patients with ATN without proliferative glomerulonephritis than in patients with proliferative glomerulonephritis (P = 0.003 and P=0.024, respectively). Conclusions: Neutrophil gelatinase associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) estimates correlated with histological signs of ATN and were able to discriminate patients with AKI even in conditions of NS. Furthermore, urinary levels of NGAL and KIM-1 may be useful in the differential diagnosis of acute tubular necrosis and exudative glomerulonephritis in patients with nephrotic syndrome.

RESUMO Introdução: O surgimento de lesão renal aguda (LRA) em pacientes com síndrome nefrótica (SN) requer diagnóstico imediato e diferenciação entre necrose tubular aguda (NTA) e glomerulonefrite proliferativa. Avaliamos o uso potencial de testes de biomarcadores urinários comerciais no diagnóstico de LRA em pacientes com SN. Métodos: Uma estimativa transversal das concentrações urinárias de KIM-1 e NGAL foi realizada em 40 pacientes com SN: 9 com glomerulopatia proliferativa, sendo 4 com LRA e 31 sem glomerulopatia proliferativa, sendo 15 com LRA. A LRA foi definida usando os critérios da KDIGO. Resultados: A média de idade foi de 35 ± 16 anos. Os principais diagnósticos foram glomeruloesclerose segmentar e focal (10, 25%), glomerulopatia membranosa (10, 25%), doença por lesão mínima (7, 18%), nefrite lúpica (6, 15%) e glomerulonefrite proliferativa (3, 8 %). Os pacientes com NTA apresentaram níveis mais elevados de KIM-1 urinário (P = 0,0157) e NGAL (P = 0,023) do que pacientes sem NTA. As concentrações urinárias de KIM-1 (P = 0,009) e NGAL (P = 0,002) foram maiores em pacientes com LRA do que em pacientes sem LRA. Os níveis urinários de NGAL e KIM-1 foram significativamente maiores em pacientes com NTA sem glomerulonefrite proliferativa do que em pacientes com glomerulonefrite proliferativa (P = 0,003 e P = 0,024, respectivamente). Conclusões: As estimativas de lipocalina associada a gelatinase de neutrófilos (NGAL) e molécula de lesão renal 1 (KIM-1) se correlacionaram com sinais histológicos de NTA, e foram capazes de discriminar pacientes com LRA mesmo em condições de SN. Além disso, os níveis urinários de NGAL e KIM-1 podem ser úteis no diagnóstico diferencial de necrose tubular aguda e glomerulonefrite exsudativa em pacientes com síndrome nefrótica.

Humans , Adult , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Nephrotic Syndrome/complications , Biomarkers , Cross-Sectional Studies , Lipocalin-2 , Kidney Function Tests
Rev. bras. cir. cardiovasc ; 36(1): 1-9, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155799


Abstract Introduction: Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient's age on risk factors for acute kidney injury after cardiac valve surgery. Methods: We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018. Results: The prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery. Conclusions: In elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure.

Humans , Male , Female , Aged , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Glomerular Filtration Rate , Heart Valves
Article in English | WPRIM | ID: wpr-880626


With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.

Acute Kidney Injury/etiology , Humans , Hypotension/etiology , Postoperative Complications/etiology , Quality of Life
Chinese Medical Journal ; (24): 172-180, 2021.
Article in English | WPRIM | ID: wpr-921256


BACKGROUND@#Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.@*METHODS@#This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan-Meier curves.@*RESULTS@#AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI (P < 0.050). Persistent AKI was independently associated with pre-operative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) (P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival (P < 0.050).@*CONCLUSIONS@#AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.

Acute Kidney Injury/etiology , Aged , Humans , Incidence , Lung Transplantation/adverse effects , Male , Renal Replacement Therapy , Retrospective Studies , Risk Factors
REVISA (Online) ; 10(1): 77-93, 2021.
Article in Portuguese | LILACS | ID: biblio-1177135


Objetivo: analisar a produção científica sobre a lesão renal aguda causada pela síndrome da Lise tumoral no paciente internado em unidade de terapia intensiva, bem como o conhecimento do enfermeiro sobre tal patologia. Método: Trata-se de um artigo de revisão integrativa realizado através da leitura de 30 artigos científicos retirados da Biblioteca Virtual de Saúde. Resultados: Identificouse a ocorrência da lesão renal aguda e síndrome de lise tumoral através das alterações metabólicas e hemodinâmicas nos pacientes internados na unidade de terapia intensiva e observou-se que não há publicações com relatos do enfermeiro sobre o conhecimento desta patologia. Conclusão: Apesar dos estudos atuais e a busca constante pelo conhecimento, sabe-se que a lesão renal aguda e Síndrome de Lise Tumoral é uma emergência oncológica com alta taxa de morbidade, onde a principal estratégia para melhorar a evolução de pacientes é estabelecer medidas profiláticas e o tratamento adequado com urgência. Deve existir uma análise contínua do enfermeiro, bem como de toda equipe, estratificação dos riscos e elaboração de protocolos de controles hidroeletrolíticos e laboratoriais para estabilização hemodinâmica do paciente oncológico na unidade de terapia intensiva.

Objective: to analyze the scientific production on acute kidney injury caused by tumor lysis syndrome in patients admitted to the intensive care unit, as well as the nurses' knowledge about such pathology. Method: This is an integrative review article carried out by reading 30 scientific articles taken from the Virtual Health Library. Results: The occurrence of acute kidney injury and tumor lysis syndrome was identified through metabolic and hemodynamic changes in patients admitted to the intensive care unit and it was observed that there are no publications with nurses' reports on the knowledge of this pathology. Conclusion: Despite current studies and the constant search for knowledge, it is known that acute kidney injury and Tumor Lysis Syndrome is an oncological emergency with a high morbidity rate, where the main strategy to improve the evolution of patients is to establish prophylactic measures and appropriate urgent treatment. There must be a continuous analysis of the nurse, as well as the entire team, risk stratification and elaboration of hydroelectrolytic and laboratory control protocols for hemodynamic stabilization of the cancer patient in the intensive care unit.

Objetivo: analizar la producción científica sobre la lesión renal aguda por síndrome de lisis tumoral en pacientes ingresados en la unidad de cuidados intensivos, así como el conocimiento de los enfermeros sobre dicha patología. Método: Se trata de un artículo de revisión integradora realizada mediante la lectura de 30 artículos científicos extraídos de la Biblioteca Virtual en Salud. Resultados: Se identificó la ocurrencia de daño renal agudo y síndrome de lisis tumoral a través de cambios metabólicos y hemodinámicos en pacientes ingresó en la unidad de cuidados intensivos y se observó que no existen publicaciones con informes de enfermeras sobre el conocimiento de esta patología. Conclusión: a pesar de los estudios actuales y la búsqueda constante de conocimiento, se sabe que la lesión renal aguda y el síndrome de lisis tumoral es una emergencia oncológica con una alta morbilidad, donde la principal estrategia para mejorar la evolución de los pacientes es establecer medidas profilácticas. y tratamiento urgente apropiado. Se debe realizar un análisis continuo de la enfermera, así como de todo el equipo, estratificación de riesgo y elaboración de protocolos de control hidroelectrolítico y de laboratorio para la estabilización hemodinámica del paciente oncológico en la unidad de cuidados intensivos.

Humans , Tumor Lysis Syndrome/complications , Health Knowledge, Attitudes, Practice , Acute Kidney Injury/etiology , Intensive Care Units , Nurse Practitioners , Tumor Lysis Syndrome/etiology
ABCD arq. bras. cir. dig ; 34(3): e1622, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1355516


ABSTRACT Background: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). Aim: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. Methods: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . Results: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. Conclusions: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.

RESUMO Racional: A incidência de hérnia abdominal em pacientes cirróticos é elevada, em torno de 20%. Em casos de ascite volumosa, a incidência atinge valores até 40%. Uma das principais e mais graves complicações no pós-operatório de correção de hérnias de pacientes cirróticos é a insuficiência renal aguda (IRA). Objetivo: Analisar a função renal de pacientes cirróticos submetidos a herniorrafias, comparando aqueles que apresentavam IRA pós-operatório com os demais, para determinar os fatores relacionados à sua ocorrência. Método: Seguimento de pacientes cirróticos submetidos à cirurgia de hérnia entre 2001 e 2014 no Serviço de Transplante de Fígado. Foram coletados exames laboratoriais para avaliar a função renal no pós-operatório rotineiramente. A IRA foi definida com base no consenso do clube da ascite em 2015. Resultados: Dos 174 pacientes incluídos, ocorreu IRA em 58 pacientes (34,9%). Houve diferença entre grupos para as seguintes variáveis: MELD inicial, creatinina basal e creatinina, o grupo com IRA apresentou medias superiores ao grupo que não apresentou IRA. No grupo IRA PO, 74,1% das cirurgias, foram realizadas em caráter de emergência, enquanto que no grupo sem IRA no pós-operatório, 34,6%. No grupo IRA, 90,4% dos indivíduos apresentaram complicações no pós-operatório, enquanto no grupo sem IRA, 29,9%. As variáveis idade, MELD inicial, creatinina basal e creatinina no pós-operatório inicial foram estatisticamente significantes na análise de sobrevida. Conclusões: Existe uma associação entre IRA pós-operatória e cirurgia de emergência e IRA pós-operatóri e complicações pós-operatórias. Os fatores relacionados à maior ocorrência de IRA em pacientes cirróticos submetidos à cirurgia de hérnia são o MELD inicial, creatinina basal, creatinina pós-operatória inicial. O preparo de pacientes cirróticos com hérnia abdominal antes de procedimentos cirúrgicos deve ocorrer sistematicamente, pois apresentam alta incidência de IRA pós-operatória.

Humans , Hernia, Abdominal , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Incidence , Retrospective Studies , Risk Factors , Abdomen , Liver Cirrhosis/complications
J. pediatr. (Rio J.) ; 96(5): 576-581, Set.-Dec. 2020. tab
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1135071


Abstract Objective: To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. Materials and methods: Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. Results: A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. Conclusion: Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.

Resumo Objetivo: Identificar os fatores de risco para o desenvolvimento de lesão renal aguda, mortalidade a curto e em longo prazo de pacientes com lesão renal aguda após internação em Unidade de Terapia Intensiva Pediátrica. Materiais e métodos: Análise retrospectiva de pacientes internados em unidade de terapia intensiva pediátrica de janeiro de 2004 a dezembro de 2008. Lesão renal aguda foi definida pelo critério KDIGO. Fatores de risco para lesão renal aguda, mortalidade hospitalar e em longo prazo foram obtidos através de análise multivariada por regressão logística. Mortalidade em longo prazo (até 2011) foi obtida através de busca no banco de dados da instituição e contato telefônico com parentes dos pacientes. Resultados: Foram avaliados 434 pacientes e a incidência de lesão renal aguda foi de 64%. A maioria dos episódios de lesão renal aguda (78%) ocorreu nas primeiras 24 horas após internação na Unidade de Terapia Intensiva Pediátrica. Os fatores de risco para o desenvolvimento de lesão renal aguda encontrados foram: baixo volume de diurese, menoridade, uso de ventilação mecânica, droga vasoativa, diurético e anfotericina. Menor peso, balanço hídrico positivo, lesão renal aguda, uso de dopamina e ventilação mecânica foram fatores de risco independentes para mortalidade hospitalar. A mortalidade em longo prazo foi de 17,8%. Pressão arterial sistólica, escore PRISM, baixo volume de diurese e ventilação mecânica foram fatores de risco independentes associados à mortalidade em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica. Conclusão: Lesão renal aguda foi um evento frequente, precoce e esteve associada à mortalidade hospitalar e em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica.

Humans , Child , Intensive Care Units, Pediatric , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Retrospective Studies , Risk Factors , Hospital Mortality , Intensive Care Units , Length of Stay
Rev. bras. cir. cardiovasc ; 35(5): 722-731, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137346


Abstract Objective: To provide a new interpretation of the effect of intraoperative hemodynamic data on postoperative acute kidney injury (AKI) development and to determine the accuracy of some biomarkers which are thought to be the early markers of renal injury. Methods: One hundred adult patients who were connected to the heart-lung pump during open-heart surgery were included in this study. Hemodynamic data, oxygen delivery, and transfusions were recorded intraoperatively, and the preoperative and 3. postoperative hour cystatin C, interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) parameters were measured for early detection of kidney damage. In the analysis, 95% significance level was used to determine the difference. Results: According to the Kidney Disease Improving Global Outcomes criterion, AKI developed in 24 patients, 18 of whom were stage 1, two were stage 2, and four were stage 3. AKI (+) patients had more transfusions in the intraoperative period and AKI development was a risk factor for postoperative complications. NGAL and IL-18 levels were found to be approximately two-fold in the postoperative period in AKI (+) patients, whereas cystatin C was not sensitive in AKI detection. Conclusion: AKI development increases the risk of postoperative complications. NGAL and IL-18 were successful in detecting AKI in the early postoperative period.

Humans , Male , Female , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications , Biomarkers/blood , Cystatin C
Arq. gastroenterol ; 57(3): 244-248, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131672


ABSTRACT BACKGROUND: Acute kidney injury (AKI) is a common and severe complication of cirrhosis. OBJECTIVE: To evaluate the impact of AKI staging on 30-day mortality of patients with cirrhosis. METHODS: We performed a retrospective cohort study of hospitalized patients with cirrhosis. Acute kidney injury (AKI) was diagnosed according to the International Club of Ascites recommendations and staged according to the European Association for the Study of the Liver guidelines. Comparisons between groups were made by one-way analysis of variance and Tukey test. Chi-square was calculated for dichotomous variables. Comparisons of renal impairment status among patients were performed using Kaplan-Meier statistics and differences between groups were analyzed using the log-rank test. A P-value <0.05 was considered to be statistically significant. RESULTS: Two hundred and thirty-two patients were included in the study. The diagnosis of AKI was performed in 98 (42.2%) of them. The overall 30-day mortality was 19.8% (46/232). Mortality increased as the degree of AKI progressed. Among patients who did not have AKI, mortality was 5.2% (7/134). When compared to patients without AKI, patients diagnosed with AKI stage 1a had mortality of 12.1% (4/33, P=0.152); patients with AKI stage 1b had mortality of 45% (18/40, P<0.001); and patients with AKI stages 2 or 3 had mortality of 68% (17/25, P<0.001). Moreover, it is noteworthy that full response to treatment was associated to a decreased mortality when compared to patients who did not show complete recovery of renal function (14.3% vs 57.9%, P<0.001). CONCLUSION: AKI stages 1b or greater, but not AKI stage 1a, are associated to higher 30-day mortality of patients with cirrhosis.

RESUMO CONTEXTO: A lesão renal aguda (LRA) é uma complicação comum e grave na cirrose. OBJETIVO: Avaliar o impacto dos estágios da LRA na mortalidade em 30 dias de pacientes com cirrose. MÉTODOS: Realizou-se um estudo de coorte retrospectivo com pacientes com cirrose hospitalizados. LRA foi diagnosticada de acordo com as recomendações do International Club of Ascites e o estadiamento foi feito de acordo com as recomendações da European Association for the Study of the Liver. Comparações entre os grupos foram feitas por análise de variância unidirecional e teste de Tukey. O teste do qui-quadrado foi calculado para variáveis categóricas. Comparações quanto à lesão renal entre os pacientes foram realizadas com estatísticas de Kaplan-Meier, e diferenças entre os grupos foram analisadas pelo teste de log-rank. Um P-valor <0,05 foi considerado estatisticamente significativo. RESULTADOS: Duzentos e trinta e dois pacientes foram incluídos no estudo. O diagnóstico de LRA foi realizado em 98 (42,2%) deles. A mortalidade geral em 30 dias foi de 19,8% (46/232). A mortalidade aumentou de acordo com a progressão dos estágios de LRA. Entre pacientes sem LRA, a mortalidade foi de 5,2% (7/134). Quando comparados aos pacientes sem LRA, pacientes diagnosticados com LRA estágio 1a tiveram mortalidade de 12,1% (4/33, P=0,152); pacientes com LRA estágio 1b tiveram mortalidade de 45% (18/40, P<0,001); e pacientes com LRA estágios 2 ou 3 tiveram mortalidade de 68% (17/25, P<0,001). Além disso, é importante ressaltar que a resposta completa ao tratamento associou-se à menor mortalidade quando comparada à ausência de recuperação completa da função renal (14,3% vs 57,9%, P<0,001). CONCLUSÃO: LRA estágios 1b ou superior, mas não estágio 1a, estão associadas à maior mortalidade em 30 dias de pacientes com cirrose.

Humans , Ascites , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Prognosis , Retrospective Studies , Risk Factors , Liver Cirrhosis/complications